Individual
MR. PETER BOETTGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
600 MOYE BLVD, LEO JENKINS CANCER CENTER, GREENVILLE, NC 27858
(252) 744-2383
(252) 744-3565
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
(252) 744-3253
(252) 744-3194
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
100862
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970005706
RAILROAD MEDICARE
NC
Enumeration date
12/19/2005
Last updated
03/04/2015
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